Medicaid is a state-operated, federally and state-funded health insurance program for low-income individuals over age 65, people with disabilities, pregnant women and children. Individuals who exceed income limits may have to spend down their current income to qualify for Medicaid. A spend down acts as a deductible; the Medicaid applicant must pay this amount out-of-pocket prior to receiving Medicaid coverage. The Social Security Administration (SSA) offers disability benefits and Supplemental Security Income (SSI) to many individuals who also qualify for Medicaid benefits. These programs provide a monthly check to be used for paying for living expenses.
Instructions
1. Determine the amount of your Medicaid spend down. Subtract your total income by the income limit for your specific type of Medicaid. This figure is your spend down. You are responsible for any medical costs up to the spend down amount. For example, if your state calculates spend downs on a monthly basis, your income is $1,190 per month, and the monthly income limit is $690, you will be required to pay the first $500 in medical costs out-of-pocket each month.
2. Review your work history and current ability to work, and contact SSA at 800-772-1213 to determine your eligibility for SSI, if you are not already receiving Social Security disability or SSI. If you are disabled and your work history is insufficient to qualify for Social Security retirement or disability benefits, you may qualify for SSI. SSI recipients are waived from paying a spend down.
3. Assess your ability to work, even if you are disabled. If you are able to maintain some type of employment, including part-time and self-employment, you may qualify for your state's Medicaid for disabled workers program. You will be waived from paying the spend down while enrolled in the program. If your income is above a certain amount, you may be required to pay a monthly premium. However, this monthly premium is always less than what your spend down would be for the same amount of income.
4. Review your out-of-pocket medical expenses and submit any out-of-pocket medical expenses that are not being counted towards your spend down to your local Medicaid office. It is common for individuals to be paying more out-of-pocket for medical costs than is actually being counted towards your spend down due to failure to turn in receipts. While this will not get your spend down waived, it will ensure that your spend down amount accurately reflects what you are actually paying out-of-pocket for medical expenses.
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